<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group hide">
        <label class="control-label col-xs-12 col-sm-2">{:__('Presentation_drug_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-presentation_drug_id" data-rule="required" class="form-control selectpage form-control" name="row[presentation_drug_id]" type="text"  value="{:$_GET['cid']}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Indication_as_reported_by_the_primary_source')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-indication_as_reported_by_the_primary_source" class="form-control form-control" name="row[indication_as_reported_by_the_primary_source]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Meddra_version_for_indication')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-meddra_version_for_indication" class="form-control form-control" name="row[meddra_version_for_indication]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Indication_meddra_code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-indication_meddra_code" data-source="meddra/index" data-show-field="en" data-show-field="en" data-primary-key="code"
                   class="form-control selectpage form-control" name="row[indication_meddra_code]">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
